Using the Teamlet Model to Improve Chronic Care in an Academic Primary Care Practice
Team care can improve management of chronic conditions, but implementing a team approach in an academic primary care clinic presents unique challenges.
To implement and evaluate the Teamlet Model, which uses health coaches working with primary care physicians to improve care for patients with diabetes and/or hypertension in an academic practice.
Process and outcome measures were compared before and during the intervention in patients seen with the Teamlet Model and in a comparison patient group.
First year family medicine residents, medical assistants, health workers, and adult patients with either type 2 diabetes or hypertension in a large public health clinic.
Health coaches, in coordination with resident primary care physicians, met with patients before and after clinic visits and called patients between visits.
Measurement of body mass index, assessment of smoking status, and formulation of a self-management plan prior to and during the intervention period for patients in the Teamlet Model group. Testing for LDL and HbA1C and the proportion of patients at goal for blood pressure, LDL, and HbA1C in the Teamlet Model and comparison groups in the year prior to and during implementation.
Teamlet patients showed improvement in all measures, though improvement was significant only for smoking, BMI, and self-management plan documentation and testing for LDL (p = 0.02), with a trend towards significance for LDL at goal (p = 0.07). Teamlet patients showed a greater, but non-significant, increase in the proportion of patients tested for HbA1C and proportion reaching goal for blood pressure, HgbA1C, and LDL compared to the comparison group patients. The difference for blood pressure was marginally significant (p = 0.06). In contrast, patients in the comparison group were significantly more likely to have had testing for LDL (P = 0.001).
The Teamlet Model may improve chronic care in academic primary care practices.
- Bodenheimer T. Building Teams in Primary Care: 15 Case Studies. California HealthCare Foundation, July, 2007. www.chcf.org. Accessed April 22, 2010.
- Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003;93:635–41. CrossRef
- Ostbye T, Yarnall KS, Krause KM, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med. 2005;3:209–14. CrossRef
- MacGregor K, Handley M, Wong S, et al. Behavior-change action plans in primary care: a feasibility study of clinicians. J Am Board Fam Med. 2006;19:215–23. CrossRef
- Sequist TD, von Glahn T, Li A, Rogers WH, Safran DG. Statewide evaluation of measuring physician delivery of self-management support in chronic disease care. J Gen Intern Med. 2009;24:939–45. CrossRef
- Feifer C, Mora A, White B, Barnett BP. Challenges to improving chronic disease care and training in residencies. Acad Med. 2006;81:696–701. CrossRef
- Bodenheimer T, Laing BY. The teamlet model of primary care. Ann Fam Med. 2007;5:457–61. CrossRef
- Laing BY, Ward L, Yeh T, Chen E, Bodenheimer T. Introducing the “teamlet”: initiating a primary care innovation at San Francisco General Hospital. Permanente J. 2008;12(2):4–9.
- Heisler M, Bouknight RR, Hayward RA, Smith DM, Kerr EA. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med. 2002;17:243–52. CrossRef
- Bodenheimer T, Handley MA. Goal-setting for behavior change in primary care: an exploration and status report. Patient Educ Couns. 2009;76:174–80. CrossRef
- Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163:83–90. CrossRef
- Neuwirth EB, Schmittdiel JA, Tallman K, Bellows J. Understanding panel management: comparative case studies of an emerging approach to population care. The Permanente Journal. 2007;11(3):16–24.
- Chin MH, Drum ML, Guillen M, Rimington A, Levie JR, Kirchhoff AC, Quinn MT, Schaefer CT. Improving and sustaining diabetes care in community health centers with the health disparities collaboratives. Med Care. 2007;45:1135–43. CrossRef
- Gensidchen J, von Korff M, Peltz M, Muth C, Beyer M, et al. Case management for depression by health care assistants in small primary care practices: a cluster randomized trial. Ann Intern Med. 2009;151:369–78.
- Using the Teamlet Model to Improve Chronic Care in an Academic Primary Care Practice
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Journal of General Internal Medicine
Volume 25, Issue 4 Supplement, pp 610-614
- Cover Date
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- primary care
- health coaching
- health care teams
- chronic illness care
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- Author Affiliations
- 1. Department of Family and Community Medicine, University of California, San Francisco, 995 Potrero Ave, San Francisco, CA, 94110, USA